Health-Care Plan Applauded As a 'Plus' for Children, Schools

WASHINGTON--When President Clinton unveiled his long-awaited plan
for overhauling the nation's health-care system last week, many
educators and child-health advocates applauded enthusiastically.

They are pleased because the President's health-care prescription
would guarantee health coverage for all Americans and include tangible
benefits for schools and children, from grants to bolster school
clinics to full coverage for childhood immunizations.

"All in all, it's a big plus for kids, and therefore schools,'' said
Michael Casserly, the executive director of the Council of the Great
City Schools.

Dr. Howard A. Pearson, the president of the American Academy of
Pediatrics, said the plan's emphasis on children is so strong that "the
academy could have written it.''

But many questions linger about the scope and logistics of the
massive health-care proposal.

A 239-page draft of the plan has been circulating in Washington, but
the Administration is expected to clarify many points in a more
detailed, final version due on Capitol Hill within two weeks.

"The Administration laid out a good proposal ... and as they say at
the race track, we are off and running,'' said Keith B. Geiger, the
president of the National Education Association.

Access for All

The plan's emphasis on "universal access'' has immediate appeal to
educators concerned about the number of children who arrive at school
with untreated health problems.

An estimated 37 million Americans are without health insurance at
any given time. According to the Children's Defense Fund, nine million
are children.

The Clinton plan would guarantee health coverage to all American
citizens that would not disappear even if they became unemployed or
changed jobs.

"We like the fact that it seems to cover teachers, who may not know
until the last minute whether or not they're going to be employed,''
said Samuel G. Sava, the executive director of the National Association
of Elementary School Principals.

The plan's potential financial effect on schools is murky. Many
observers predict that school districts' health-care bills would remain
relatively stable under Mr. Clinton's reform scheme. Large districts
with 5,000 or more employees could form their own health alliances and
offer coverage to their employees. But smaller districts, like small
businesses, may initially see their health-care costs increase. (See
story, page 1.)

"My guess is state legislators will have to find some way to help
them recover,'' said Bruce Hunter, a senior associate executive
director of the American Association of School Administrators.

The Administration's plan to create standardized forms and
"health-security cards'' may help reduce costs for administrators by
eliminating paperwork, Mr. Hunter added.

Emphasis on Prevention

The proposal's emphasis on prevention has been welcomed by education
representatives and child advocates with particular enthusiasm.

Under the plan, all children would receive all medically necessary
vaccines by age 2. Preventive dental and eye care for children under 18
would also be covered. In addition, the plan calls for new federal
grants supporting health-education and other initiatives designed to
prevent substance abuse and AIDS in adolescents, as well as childhood
mental disorders.

"In general, anything that targets preventive health efforts will
have enormous payoffs later and is worth endorsing,'' said Mr.
Casserly.

"This is certainly a major improvement,'' said Becky Smith, the
executive director of the Association for the Advancement of Health
Education, adding that health education has typically been viewed as a
luxury, rather than a central component of disease-prevention
efforts.

Some health-education funding is expected to flow to schools.

"Schools will be an information center for parents to provide them
with necessary information,'' said Mr. Sava.

But Dr. Pearson of the A.A.P. criticized the Clinton plan's
limitation on routine medical checkups. The proposal would cover seven
visits to the doctor during a child's first two years and two more
between the ages of 3 and 5, but only seven visits would be covered
between the ages of 6 and 19.

"The plan short-changes adolescents,'' said Dr. Pearson, arguing
that adolescents should have annual checkups.

School Nursing Prominent

The plan's emphasis on prevention is likely to be a boon to school
nurses, as preventive care is at the core of their mission, said
Melinda E. Mercer, a lobbyist for the American Nurses Association.

School nurses would probably play an enhanced role under the
proposal, as it calls for increases in the number and scope of
school-based and school-linked health centers, Ms. Mercer noted.

Under the plan, school clinics would automatically qualify for
reimbursement from health plans for services provided to students. (See
Education Week, Sept. 22, 1993.)

"Clinics will most likely look different from community to
community,'' said Ms. Mercer, adding that schools will be places where
"new and exciting things [will be] happening.''

Special Education

While the proposal does not specifically address special education,
some advocates speculated that healthcare reform may ultimately affect
the way special education is financed. For example, it might shift some
of the cost of serving medically fragile children away from
schools.

Mr. Hunter of the A.A.S.A. suggested that the reforms could
indirectly drive down the cost of serving disabled students by reducing
the number of birth defects, since prenatal care is covered.

"It's too early to tell how [health-care reform] would ultimately
affect educational institutions,'' said George Ayer, the executive
director of the Council for Exceptional Children.

However, he said, because the plan prohibits discriminiation based
on pre-existing conditions and offers mental-health benefits for
children, it would probably have a positive impact on students with
disabilities.

Mental-Health Benefits

But some mental-health advocates charge that the plan's standard
package of benefits fails to provide adequate coverage for the
treatment of mental illness.

For example, the plan would limit coverage for inpatient
mental-health treatment to 30 days per episode, with an annual limit of
60 days.

"Children seldom need hospitalization, but when they do it is
extremely serious,'' said Mary P. Crosby, the director of government
affairs for the American Academy of Child and Adolescent
Psychiatry.

She said the academy will push for unlimited inpatient coverage for
children and adolescents.

Indeed, lobbyists representing an unusually broad panorama of
interest groups are drawing up their battle plans for the months of
legislative scrutiny that lie ahead. While most observers predicted
that Congress would eventually enact some kind of health-care-reform
package, they suggested that the final product may barely resemble the
Clinton plan at all.

For example, Congressional Republicans have already issued a
competing proposal that aims to provide universal health coverage
within seven years.

The plan would not require employers to foot the bill for employees'
health care, but would provide tax breaks to make it easier for
businesses and individuals to purchase insurance, and allow small
companies to increase their bargaining power by forming collectives.
Poor people would receive government vouchers with which to purchase
insurance. Insurers would be barred from excluding people who are
sick.

Unlike the Administration plan, the Republican alternative would not
specify which benefits must be covered; instead, a national commission
would establish a minimum-benefit package that could be considerably
less comprehensive than the one the President envisions.

Since the education community is generally pleased with the
President's proposal, its representatives are gearing up to protect
what they view as its child-friendly features.

"Its going to be a long and tough debate because the devil is partly
in the details,'' said Martin Blank, a senior executive at the
Institute for Education Leadership.

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